Wang Kun, Yi Hang, Lv Zhuoheng, Jin Donghui, Fu Li, Mao Yousheng
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Ther Adv Med Oncol. 2024 Jul 31;16:17588359241265214. doi: 10.1177/17588359241265214. eCollection 2024.
Neoadjuvant therapy improves survival benefits in patients with locally advanced non-small cell lung cancer but increases tissue density, presenting challenges for surgeons.
To compare the differences in surgical complexity and short-term prognostic outcomes between neoadjuvant targeted therapy (NTT) and neoadjuvant chemoimmunotherapy (NCI).
DESIGN/METHODS: This study enrolled 106 patients underwent curative surgery after neoadjuvant therapy between January 2020 and December 2023 at the National Cancer Center of China. Differences in surgical complexity and short-term prognostic outcomes between the two neoadjuvant therapy cohorts were evaluated. The pathological indicators such as pathological response rate and lymph node upstaging/downstaging were then analyzed.
In total, 33 patients underwent NTT and 73 underwent NCI preoperatively. Patients who received NTT showed a higher minimally invasive surgery rate (84.8% 53.4%, < 0.01), shorter operative time (144 184 min, < 0.01), lower conversion rate (3.3% 17.8%, = 0.03), less postoperative drainage (day 3: 140 200 mL, = 0.03), and lower incidence of postoperative complications including arrhythmias (6.1% 26%, = 0.02). The pathological response rate in the NTT and NCI groups was 70% and 75%, respectively, with the latter group showing a higher complete pathological response rate. The two groups had no significant differences in major pathological response and lymph node pathological response rate.
Patients who received NTT presented fewer surgical challenges for surgeons and had better surgical outcomes than those who received NCI therapy, with comparable pathological response rates between the two cohorts. Accordingly, NTT is the preferred induction regimen for patients harboring mutation status.
新辅助治疗可提高局部晚期非小细胞肺癌患者的生存获益，但会增加组织密度，给外科医生带来挑战。
比较新辅助靶向治疗（NTT）和新辅助化疗免疫治疗（NCI）在手术复杂性和短期预后结果方面的差异。
设计/方法：本研究纳入了2020年1月至2023年12月在中国国家癌症中心接受新辅助治疗后接受根治性手术的106例患者。评估了两个新辅助治疗队列在手术复杂性和短期预后结果方面的差异。然后分析了病理反应率和淋巴结分期上调/下调等病理指标。
共有33例患者术前接受了NTT，73例接受了NCI。接受NTT的患者微创手术率更高（84.8%对53.4%，P<0.01），手术时间更短（144对184分钟，P<＜0.01），转化率更低（3.3%对17.8%，P=0.03），术后引流量更少（第3天：140对200毫升，P=0.03），术后并发症包括心律失常的发生率更低（6.1%对26%，P=0.02）。NTT组和NCI组的病理反应率分别为70%和75%，后者的完全病理反应率更高。两组在主要病理反应和淋巴结病理反应率方面无显著差异。
与接受NCI治疗的患者相比，接受NTT的患者给外科医生带来的手术挑战更少，手术结果更好，两组的病理反应率相当。因此，NTT是具有突变状态患者的首选诱导方案。
